SNUD Committee Meeting

37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Thursday, June 13, 2002

¹

1540

The Chair (Ms. Paddy Torsney (Burlington, Lib.))

Mr. Jean-Sébastien Fallu (Groupe de recherche et d'intervention psychosociale de Montréal)

¹

1545

The Chair

Dr. Peter Vamos (Director, Centre d'accueil le Programme Portage)

The Chair

Mr. Sorenson

The Chair

Mr. Jean-Sébastien Fallu

The Chair

Mr. Jean-Sébastien Fallu

Mr. Kevin Sorenson

The Chair

Mr. Jean-Sébastien Fallu

The Chair

Dr. Peter Vamos

¹

1550

¹

1555

º

1600

The Chair

Ms. Carole Morissette (Individual Presentation)

º

1605

º

1610

º

1615

The Chair

Dr. Mark Zoccolillo (Associate Professor of Psychiatry and Assistant Professor of Pediatrics, McGill University)

º

1620

º

1625

º

1630

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

The Chair

Mr. Mac Harb (Ottawa Centre, Lib.)

Mr. Réal Ménard

The Chair

Mr. Derek Lee (Scarborough—Rouge River, Lib.)

The Chair

Mr. Réal Ménard

Ms. Carole Morissette

º

1635

Mr. Réal Ménard

Dr. Mark Zoccolillo

Mr. Réal Ménard

Dr. Mark Zoccolillo

Mr. Jean-Sébastien Fallu

º

1640

Mr. Réal Ménard

Dr. Mark Zoccolillo

Mr. Réal Ménard

Dr. Mark Zoccolillo

Mr. Réal Ménard

The Chair

Mr. Mac Harb

Dr. Mark Zoccolillo

Mr. Mac Harb

Dr. Mark Zoccolillo

Mr. Mac Harb

º

1645

Dr. Mark Zoccolillo

Mr. Mac Harb

Dr. Mark Zoccolillo

Mr. Mac Harb

Ms. Carole Morissette

Mr. Mac Harb

Mr. Jean-Sébastien Fallu

The Chair

Dr. Peter Vamos

º

1650

The Chair

Ms. Carole Morissette

The Chair

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.)

º

1655

Ms. Carole Morissette

Mr. Dominic LeBlanc

Ms. Carole Morissette

»

1700

Mr. Dominic LeBlanc

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Peter Vamos

The Chair

»

1705

Dr. Peter Vamos

The Chair

Dr. Peter Vamos

»

1710

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

»

1715

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Dr. Mark Zoccolillo

The Chair

Mr. Jean-Sébastien Fallu

Mr. Lee

Dr. Mark Zoccolillo

»

1720

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

Dr. Mark Zoccolillo

Mr. Derek Lee

The Chair

Mr. Jean-Sébastien Fallu

The Chair

Ms. Carole Morissette

»

1725

The Chair

Dr. Peter Vamos

The Chair

Ms. Carole Morissette

»

1730

The Chair

Ms. Carole Morissette

The Chair

Ms. Carole Morissette

The Chair

Mr. Réal Ménard

»

1735

Dr. Mark Zoccolillo

The Chair

Mr. Jean-Sébastien Fallu

»

1740

Mr. Réal Ménard

Mr. Jean-Sébastien Fallu

Mr. Réal Ménard

Ms. Carole Morissette

The Chair

Dr. Mark Zoccolillo

An hon. member

Mr. Jean-Sébastien Fallu

The Chair

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CANADA

Special Committee on Non-Medical Use of Drugs

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NUMBER 051

l

1st SESSION

l

37th PARLIAMENT

---

EVIDENCE

Thursday, June 13, 2002

[Recorded by Electronic Apparatus]

¹  (1540)  

[English]

    The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I call this meeting to order. We are the Special Committee on Non-Medical Use of Drugs. We were struck, as of last May, on an order from the House of Commons to consider the factors underlying or relating to the non-medical use of drugs. In April of this year we were also referred the subject matter of Bill C-344, an act to amend the Contraventions Act and the Controlled Drugs and Substances Act related to marijuana, which is a private member's bill.

    We are very pleased to have with us today as witnesses, Dr. Carol Morissette, specialiste en santé communautaire, as an individual; from McGill University, Dr. Mark Zoccolillo, associate professor of psychiatry and assistant professor of pediatrics; from the Centre d'accueil le Programme Portage, we are very pleased to have Dr. Peter Vamos, who is the director; and from le Groupe de recherche d'intérêt public au Québec, Jean-Sébastien Fallu.

[Translation]

    Welcome, everyone. We will start with Mr. Fallu or Mr. Vamos.

    Mr. Jean-Sébastien Fallu (Groupe de recherche et d'intervention psychosociale de Montréal): Good afternoon.

    First, we are the Groupe de recherche et d'intervention psychosociale.

    If I've understood correctly, we have been asked to speak today about the reasons why people use drugs prescribed for medical purposes for non-medical purposes and what should be done about this phenomenon.

    First, I would like to recall a number of facts. Drug use is universal. Even certain animals use drugs in a non-medical fashion. Before crossing the tundra, the wapiti consumes and chews cocoa leaves in a truly utilitarian, non-medical manner. We realize that, in Quebec, as many as 60 percent of youths under 18 years of age have previously used marijuana, which is quite disturbing and odd in light of the legal situation. We also realize that many young people who have no psychosocial adaptation problems use drugs experimentally. There are even studies that show that youths who experiment with drugs were in better mental health in early childhood and will remain that way until the end of adolescence and in early adulthood than those who abuse or never use drugs. That's quite interesting.

    It should also be borne in mind that the classification of drugs in our society is based more on political, cultural and economic than pharmacological criteria, as a result of which a number of legal substances are more toxic than illegal substances. This is one factor among others that can push certain individuals to make an objective choice to use illegal drugs that are less toxic than legal drugs.

    We also realize that drug use prevention does not really work. With people who are already using drugs, prevention simply does not work at all. That's why it is increasingly thought that we should move toward harm reduction policies which would supplement other approaches and other objectives designed to delay use, delay abuse and prevent, as far as possible, a variety of drugs from being available.

    However, the first objective of any social policy is surely to reduce harm and prevent negative impact. In addition, it should not be forgotten that, in every drug use situation, the legislation leaves the criminal world considerable room to make big profits. However, that money, it should be borne in mind, is used to corrupt individuals. It is not my wish to single anyone out, but there will always be individuals who will give in to the temptation of one or two years' salary to close their eyes to a minor incident.

    We also realize that, for young people, pot and soft drugs are more accessible than tobacco, on which we have legislated. It is hard to buy drygs at the convenience store, so drug dealers move about in the streets nearby. We should also keep in mind that legislation preventing use before the age of 18 is a double-edged sword. We're sending a twofold message. We're telling young people that, if they use drugs, they are symbolically adults. Consequently, in some cases, that encourages young people to use.

    We often talk about the consequences of drug use, but we have to be careful. When we consider the personal characteristics of individuals, we realize that often the consequences that may be associated with drugs are ultimately consequences of the concomitant personal characteristics and appear to be interrelated, but that is often only mere coincidence.

    As the studies show, the law often actually reduces use, and thus limits abuse. But that does not eliminate the problem, and the law alone cannot solve the problems of the non-medical use of drugs.

    For us, at GRIP, education is definitely very important in countering the risks and developing social skills in young people and teenagers. It is also important for our projects, such as the project to provide a public testing service, meaning to offer people a service to check the quality of the substances they have purchased illegally. We have to be realistic: despite the illegal nature of non-medical drug use, there have always been and will always be people who use drugs.

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    This problem must be given serious consideration. In our view, verifying the quality of psychotropic substances is one way to do so, but not the only one. I spoke about education; there is also information on ways of reducing risks. Obviously, if we look at actions such as Operation Red Nose, and we want to eliminate drug use through a program such as that, it won't work. But if our objective is to reduce harm, to ensure that people do not drive while drunk, Operation Red Nose works. I say that because we often evaluate prevention programs and social policies in terms of abstinence. But if we slightly changed our ways of evaluating the operation and effectiveness of the intervention, we could see that we can reduce harm. Some studies show that we can reduce harm, and that's effective, contrary to utopian objectives of abstinence.

    Social alienation is one of the factors that lead people to use drugs. There are a number. There are individual, environmental factors. I could name a number. I know that you are interested in knowing the factors. I believe that the alienation young people feel in capitalist, productivist society is one. I believe--and this is an opinion--that this correlates with the increase in drug use.

    I don't know whether that meets your expectations somewhat. I was not given a lot of instructions on the subject. That's what I have prepared.

[English]

    The Chair: Merci beaucoup.

    Dr. Vamos.

    Dr. Peter Vamos (Director, Centre de réadaptation Le Portage): Merci. Thank you.

    I'm Peter Vamos. I'm the executive director of the Portage program.

    The Chair: Just a second, please.

    Mr. Sorenson, do you have a question?

    Mr. Kevin Sorenson (Crowfoot, Canadian Alliance): Yes, I'm just wondering where the....

[Translation]

    The Chair: Mr. Fallu, could you repeat the name of your group?

    Mr. Jean-Sébastien Fallu: Yes, it's GRIP de Montréal.

[English]

It's not the other GRIP.

[Translation]

    The Chair: GRIP de Montréal.

    Mr. Jean-Sébastien Fallu: It's the Groupe de recherche et d'intervention psychosociale.

[English]

    Mr. Kevin Sorenson: I'm just wondering, we don't have the English interpretation of the psychosocial intervention and research group.

    The Chair: When it's a proper name of an organization, you use the French, and the same in English.

    Is it “Intervention publique au Québec” ou “à Montréal”?

[Translation]

    Mr. Jean-Sébastien Fallu: We are the Groupe de recherche et d'intervention psychosociale de Montréal.

[English]

    The Chair: Merci beaucoup.

    Je m'excuse, Doctor Vamos.

    Dr. Peter Vamos: Good afternoon, ladies and gentlemen.

    I'm Peter Vamos. I'm the executive director of the Portage program. The Portage program is Canada's oldest and largest therapeutic community for the treatment of addictions. Portage was founded in Montreal in 1970 by a coalition of community leaders, professionals, and volunteers representing both the French and English communities who were concerned about the drug problem in the city.

    Portage opened its first treatment centre in the Laurentian mountains north of Montreal in 1973. Over the years, Portage has expanded its services in the province of Quebec to Quebec City and the eastern region, in addition to opening treatment centres in Ontario and New Brunswick.

    In January 2001, Portage inaugurated a new treatment centre on the West Island of Montreal to provide services to anglophone adolescents. Portage currently operates ten treatment centres in Canada and has also helped to establish treatment centres in Europe, Asia, and elsewhere in North America. Portage offers both ambulatory and residential treatment services to male and female adults, adolescents, drug-addicted women with small children, mentally ill substance users, as well as delinquents with drug-related problems.

    Portage also provides training and consulting services on addictions in the fields of health, education, and justice. Portage is a not-for-profit organization financed through the support of the public and private sectors. A 25-member board of trustees oversees the operations of the organization, and the interests of the community are represented on its 150-member national board of governors. Daily administration of the programs is under the charge of an executive director--me--and a management team responsible for finance, administration, communication, and development.

    Portage is recognized as a cost-effective treatment option, because the program places strong emphasis on self-sufficiency and residents assist in maintaining the day-to-day operations of the treatment centres as part of their therapy. The Portage treatment approach is based on the principles of the therapeutic community: people helping people, and self-help. Portage employs a number of therapeutic techniques, including role modelling, group and individual counselling, and collaborative treatment planning to help residents change their behaviour. Our residents learn how to think, how to handle strong emotions, and how to get along with others.

    Education and sports also play an important role in our treatment program. At each of the Portage facilities, Portage provides a specialized educational program for both adolescents and adults. The philosophy of the Portage academy--and this is how we refer to our school programs--is based on a self-enhancing education model. At the Portage academy, the clients work at their own speed in small classrooms using a modular curriculum. The educational program is an integral part of our treatment process and ensures that those clients who need to have an opportunity to complete their high school leaving certificates do so during their stay in Portage. We have been very fortunate in all provinces to have had excellent cooperation from ministries of education to achieve this goal.

    Portage offers a continuum of care, providing constant support for residents and their families from the stage of pre-admission and for one year after treatment completion. Portage believes first and foremost that treatment works and that addiction can be beaten. Portage recognizes the power of people to heal themselves and that healing is possible through the therapeutic power of the community. Portage views addictions both as a health issue and as a symptom of poor psychosocial adjustment, one that makes fulfilling relationships difficult and prompts individuals to seek escape from life's stresses through drugs.

    The Portage therapeutic community emphasizes social learning. Portage believes that by taking responsibility for one's own problems and behaviours, one becomes responsible and self-reliant, and in turn can become a credible role model for others. An important goal of treatment is to help change negative behaviours and attitudes that may lead to drug use and other maladaptive behaviours and to assist in the development of responsible individuals with appropriate lifestyles.

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    The primary therapist in the therapeutic community is the community itself, which consists of the social environment, peers, and staff members, who, as successful role models, serve as guides in the process of recovery. Many activities of the therapeutic community are programmed in collective formats that are designed to produce therapeutic change in the participants. Learning occurs by participating in various activities and assuming various roles and responsibilities. Clients demonstrating the expected behaviour that reflects the values of the community become role models. Social learning takes place as a consequence of positive peer modelling and the use of peer feedback and peer pressure.

    The therapeutic community has a set of explicit behavioural norms, rules and regulations, that protect the physical and psychological safety of the community. In this enriched environment the client has an opportunity to generate their own positive value systems and attitudes that are a sina qua non for self-recovery.

    Over the years, therapeutic communities have produced remarkable results with some very hard-to-serve populations. It has had a profound impact on individuals, significantly increasing their ability to cope with the challenges of everyday life.

    Portage pays particular attention to individual differences and needs. The Portage therapeutic community model has at its core a system of case management.

    Case management in the therapeutic community ensures that the individual clients are always aware of what they are working on and why and also how to measure their progress. Each client is assigned to a case manager, and each resident, with the aid of his staff, develops a bi-weekly personal treatment plan. Each client is the subject of a multi-disciplinary case conference once a month.

    The case management system also helps to move the therapeutic community experience to an objective level, where progress and growth are observable and measurable phenomena.

    Portage's expectations as to what a client can achieve as a result of their therapeutic community experience led to the identification of a number of behavioural and attitudinal competencies that allow a person to successfully cope with life's challenges while respecting their own needs and values.

    It is the acquisition of these competencies that is the ultimate goal of the therapeutic experience. Some examples of these competencies are the ability to ask for help, the ability to take initiatives, the ability to actively participate in treatment, the ability to communicate effectively, the ability to show consistency, to be organized and orderly, the ability to manage feelings appropriately, etc. There are currently 22 major competencies that we are working on with our residents.

    Progress and position in the treatment progress is achieved by mastering the required competencies. Objective examinations coupled with peer and staff observations are the means by which a resident advances in treatment. Even one day in treatment results in some learning. To master the curriculum of competencies is to have completed the treatment process.

    At the outset of treatment, each resident starts at a different point on the competency continuum. How long they spend in treatment is a function of where they start from and how far they wish to progress. They know in the induction phase of our treatment what they can learn. It is the residents who determine what is relevant and important for them. Even though the process is completely individualized, the average residential stay is approximately six months.

    Competency-based treatment requires a client-centred philosophy. Punishment, humiliation, and shame have no place in a positive learning environment. Rather, the goal is to provide a psychologically safe and physically secure community in which self-help can occur.

    The Portage process incorporates the universally accepted core conditions that are required for therapeutic gain, namely, genuineness, respect, concreteness, and unconditional positive regard, as the operating principles of the therapeutic community. Portage believes it can do far more good by increasing self-esteem than by breaking down negative images.

    The Portage treatment program is gender-sensitive, with emphasis being placed on gender-specific activities.

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    Portage sees itself as part of a continuum of care in treatment, forging strong working relationships with other complementary service providers. Through synergy, it hopes to marshal all the resources of the greater community to support its clients' recovery.

    Portage works with its clients both before and after their residential stay. A comprehensive admission and evaluation phase proceeds acute treatment, while re-entry and after-care services are offered post-residence. The entire process lasts two years.

    As part of its after-care program, Portage offers its clients ongoing individual and group counselling, relapse prevention, family therapy, work readiness training, and job placement services. Portage aims for the clients' reconciliation with their significant others and their community and their successful reintegration into that community.

    Organizations like Portage are proof that treatment works. In 29 years of experience, I have learned that you cannot legislate drug abuse out of existence; you cannot rehabilitate an addict or restore them to their family through punishment.

    We Canadians think of ourselves as a kinder, gentler society. We speak of harm reduction and restorative justice as our governing philosophies. We must ensure that our practices in dealing with addiction are as enlightened as our lofty ideals.

    Thank you.

º  (1600)  

    The Chair: Thank you very much, Dr. Vamos.

    Now, from McGill University, we have Dr. Mark Zoccolillo.

[Translation]

    Instead, we'll hear from Dr. Carole Morissette first.

    Ms. Carole Morissette (Individual Presentation): Good afternoon, ladies and gentlemen, first of all, I would like to thank the committee for the invitation that was sent to me.

    I am Dr. Carole Morissette, and I am a physician specializing in community health. I have practised in the field of prevention of diseases transmissible through blood and sexual activity involving injection drug users for 10 years now. It is in that capacity that I have come here to talk to you about my concerns in this area. I also hope to be able to answer some of your questions.

    I am not in a position to conduct an exhaustive analysis of the National Drug Strategy or to talk about its impact on Montreal. However, I can talk to you about drug addicts, their state of health and their living conditions, but also about the state of existing programs and services. I can also tell you about the conditions of and barriers to the introduction of such programs.

    First, for regions such as Montreal, it can be said that the actions of social and health players is determined by a certain number of factors, first, affecting the state of knowledge about vulnerable populations and groups. Here I'm thinking about young people who are at risk of drug use. I'm also thinking of street youths and especially of people who use drugs, particularly intravenously, of the search for preventive solutions and effective actions and of strategies for the deployment of measures known to be effective. Of course, the degree to which these measures are used depends on implementation conditions such as those experienced in the field.

    Programs will therefore be influenced by public perceptions of the problem and the proposed response, as well as by the will of local decision-makers and of those who can offer their support.

    Furthermore, the actions of many players from various sectors, health, public security, education, housing, etc., depend on the orientations of the strategies put forward by the various levels of government, based on the constraints and organizations of each. In saying that, I am not telling you anything new, but this gives you an idea of all the factors that must be considered when it comes to considering the relevance and effect of a Canadian drug strategy in a region such as Montreal.

    First, let's talk about the state of knowledge about the health of vulnerable groups. The illegal nature of street drug use and the social exclusion of drug users make it a more complex task to monitor the state of their health. Without being too mistaken, it can be said that, over the past 10 years, AIDS research programs have made it possible to gain greater knowledge of this hard-to-reach population of intravenous drug users and to know it better. These research efforts must be maintained and reinforced. There are still many unknowns in the socio-health situation of drug addicts and health questions relating to the use of drugs in Canada and elsewhere.

    With regard to the characteristics of drugs, for example, existing data from Canadian laboratories are there to respond to the imperatives of police investigations, but not so much for public health issues. We do not know enough about youth trajectories which lead to a street lifestyle or about the determining factors that lead people to become intravenous users. There is no monitoring system for severe intoxication or drug-related deaths. A flexible health information and monitoring system capable of detecting trends will therefore have to be put in place to determine the availability, type and quality of street drugs, the use profile in terms of transitions in drug use, but also in methods of use, and various social and health aspects, including transmittable diseases, but other problems as well.

    These are only a few examples of the gaps that must be filled in our knowledge and monitoring. Thus the task is to develop indicators that cover a set of social and health problems.

    As to the search for preventive solutions and effective actions, efforts to identify and select actions must be based not only on the literature but also on consultation with experts and various environments.

º  (1605)  

    In the field of intervention with street drug users, there is of course a literature, but there is also a large degree of uncertainty. First, a number of potential solutions have been explored little or not at all. Sometimes it is difficult, ethically and methodologically, to evaluate certain projects beyond any doubt.

    Efforts must be made to develop research projects that can help reach sound judgments on the appropriateness and effectiveness of innovative solutions in the Canadian context.

    A number of initiatives have been taken elsewhere, but it is essential that they be experimented with and evaluated before any judgment can be made in one direction or another. The project to prescribe heroin for medical purposes is a very good example of this type of pilot project, as are medically supervised injection sites, as recommended in the FPT committee report on intravenous drug use in Canada.

    In the area of opiate use, there are a number of projects and treatments that have proven their worth. However, with regard to cocaine use, which is very widespread in Montreal and in other Canadian urban areas, we have no clear guidelines on effective recognized treatments. So this is a very important research area in Canada.

    As for the introduction of strategies and the deployment of recognized effective measures, research and development needs are very great. Even for measures already recognized as appropriate and effective, it is not possible to proceed with their deployment at the present time. We realize that there is a gap, at the time of evaluation, between the services in place and public needs.

    I'll give you a brief example, that of Montreal. In Montreal, there are approximately 12,000 intravenous drug users and several thousands of street youths aged 13 to 25, approximately half of whom have previously injected drugs. An estimated eight percent of those young people begin taking drugs intravenously every year.

    The incidence of HIV infection among intravenous drug users has remained high at approximately six percent per year. Eighty percent of those individuals have been infected by the Hepatitis C virus. The prevention challenge is thus among young people, who are at risk of intravenous drug use, but also, and especially, among young intravenous drug users.

    There are also premature deaths mainly caused by overdoses, voluntary and otherwise, suicide and accident. In the cohort of Montreal street youths, we have observed mortality rates 10 times greater than those among young Quebeckers of the same age.

    Drug addiction is often a solution alleviating various problems such as depression. Involuntary overdoses are also related to mixtures and lack of experience, but also to a lack of stability in drug quality and purity.

    The existing services are clearly insufficient to address all these problems. For example, in the area of transmissible disease prevention, there are five community needle exchange programs in Montreal and approximately 25 other community and institutional partners offering the same service. There are also seven CLSCs and 150 pharmacies that sell syringes without prescription.

    Nevertheless, at the present time, approximately one million syringes are distributed or sold in Montreal every year. Although that figure has risen since 1995, it remains suboptimal and represents only 10 percent of estimated needs.

    Methadone access is also lacking. Fewer than 1,500 persons are currently under methadone treatment, whereas the number of spaces needed to reach 50 percent of those who could benefit from treatment is 2,500. Several hundreds of individuals are currently waiting. Access to medical services and accommodation is also lacking, as are prison and social housing services and social reintegration services.

    So what conditions influence the introduction and deployment of these effective measures? The main conditions are funding and the legal framework, as well as public policies and coordination of efforts.

    Funding must be sufficient, sustained and recurring. At present, that's the status quo in development. Program funding has been stable for a number of years, whereas needs, in terms of the deployment of a minimum level of services, are not being met.

º  (1610)  

Drug addiction is still not the top priority, as a result of which it is very often AIDS prevention initiatives that help to partially offset the lack.

    Furthermore, it is not unusual for orientations to be developed without support mechanisms or funding being set aside for their implementation. This is often what makes the difference in terms of effectiveness. It is difficult to judge the effectiveness of measures that are only partially implemented.

    There is also the time factor. In most cases, we cannot expect measurable results unless intervention is sustained and intensive. That's why pilot projects, even if necessary and promising, are insufficient if continuous funding is not provided.

    There is the legal framework. I'm sure you've had the opportunity to hear of or read some of the documents that have been produced, either in the context of the FPT committee's work on intravenous drug use in Canada or in documents produced by the Canadian Legal Network. These reports are highly relevant. They should be seriously considered by the committee. This is an essential condition for examining the appropriateness and effectiveness of the National Drug Strategy.

    I'm not a legal expert; I am a doctor, but I can tell you that, over the past 10 years, I've seen situations in the field that have corroborated the idea that enforcement can undermine health and prevention actions. The legal approach is not always the most appropriate.

    We are incarcerating young street people because they are unable to pay fines imposed for minor offences such as sleeping on park benches or crossing against red lights. In many cases, those youths are depressed and suffering serious mental health problems which thus remain undetected and untreated. More prison services must be offered in order to avoid revolving door problems.

    We are also familiar with the problems we have had over the past more than 10 years in the field in agreeing on the notion of a tolerance zone with regard to public health actions, whether with regard to the intervention of street workers, police monitoring and arrests in relation to needle exchange programs or the confiscation of new or used needles and so on.

    This represents a challenge. How many times in the field have discussions ended with the observation that there are Canadian drug laws which provide the basis for public security mandates? Unless the act is revised, it is impossible to hope for any changes in practices.

    Recent research on medically supervised drug injection sites raises a series of questions that have remained more or less in abeyance until now. It can be said that needle exchange programs have been tolerated, but, as a result of the legal framework, those organizations have difficulty finding insurers for their premises, for example. Although the public health action is recognized, they often find themselves wrongly in a climate of illegality.

    Lastly, public policies and coordination of efforts. Illegality is also the corollary of the lack of recognition of the public health nature of the problem, which is reflected in public policies and institutional regulations. And yet those policies have an effect on the consequences of drug addiction as well as on its causes. Harm reduction is not only a model based on transmissible diseases. As can be seen here, harm reduction encompasses the full range of public health actions, from health promotion to tertiary prevention. This includes access to services as much as social environment, coalitions of users for the defence of rights and fair access to housing, education and employment.

    When I say access to services, that obviously includes services advocating abstinence and treatment. Conditions for admission to institutions in the network for marginalized persons, the restrictive nature of methadone treatment and the difficulty that drug addicts have in leaving the street life and returning to society are examples in which public policies can have an influence.

    Significant efforts have been made in recent years to improve the coordination and harmonization of approaches across the various sectors. A number of recommendations have been made by multisectoral committees, including this one. Those recommendations are serious and must be considered. They emphasize the importance of leadership in health, of the harmonization of actions across various departments and of certain concrete actions that can support the deployment of actions locally.

º  (1615)  

    In conclusion, I hope I have convinced the committee of the relevance of a drug use strategy so that there is leadership in health, that is to say in the area of knowledge and monitoring of the health of Canadians, and the search for and development of effective action. That would support the development of drug addiction research, while fostering development of a multidisciplinary approach. It would also support the development of infrastructure for the ongoing monitoring of addictions and their social and public health consequences and, lastly, for the optimization of conditions for the implementation of strategies, that is in the coordination of intersectoral actions across Canada, particularly with regard to public policies and the legal framework.

    Thank you for your attention.

[English]

    The Chair: Merci beaucoup, Dr. Morissette.

    Dr. Zoccolillo.

    While Dr. Zoccolillo gets set up, some of us on the committee have had the chance to visit Portage, certainly the program in Elora, Ontario, with youth. I remember recalling some of the process you were putting the kids through in terms of being accountable. Having sat in the House for a while, you might want to do some work with some of our colleagues in terms of being accountable for their actions and calling each other on misbehaviours.

    Dr. Mark Zoccolillo (Associate Professor of Psychiatry and Assistant Professor of Pediatrics, McGill University): Thank you. I want to talk today about adolescent marijuana and hallucinogen use: why we should be concerned and implications for public policy.

     This study we did is subtitled “Problem drug use in Quebec adolescents“. My colleagues are Frank Vitaro and Richard Tremblay from the University of Montreal and the other GRIP funded by various grant agencies.

    I'm going to describe the study and then some implications. This is a representative sample of 879 boys and 929 girls who are representative of Quebec adolescents in francophone school boards throughout Quebec. They were surveyed from 1995 to 1997. Among other things, they were given a self-administered questionnaire on drug and alcohol use along with many other interviews and assessments.

    This is the age of the group. What I want you to notice is they're mostly 15 and 16. Two-thirds are 15. That's important. We're not talking about college students. We're talking about high school students. The majority were in ninth or tenth grade. The next largest group was in seventh or eighth grade, and so again largely ninth or tenth graders.

    What we did was we asked them in this questionnaire that they filled out confidentially whether they had ever used illegal drugs and whether they had ever used illegal drugs more than five times. We used the five times just as a cut-off in terms of asking further questions.

    What you can see is two things. First, about one-third of all the adolescents had used illegal drugs more than five times by this age, and there are no gender differences, a pattern that will be continued throughout the presentation.

    Of the drugs used, all of the adolescents who had used drugs had used marijuana. The next most common group is the hallucinogens, which is about 20% of all adolescents, and the remainder were between, as you can see, 6% and 1% for the other drug groups.

    What we did, though, is we asked the adolescents who have used illegal drugs more than five times, which again is one-third of all adolescents, where and under what circumstances they had used drugs. This is one of the first studies, as far as I know, that has ever done this in a large sample.

    What we found was that of those adolescents who reported using drugs more than five times, 79% of the boys and 69% of the girls reported they had been drugged or high while at school. Similar figures, again, reported that they had been under the influence of drugs while riding a bicycle, rollerblading, playing sports. Again a similar proportion reported that they had used drugs in the morning.

    Smaller but still significant proportions certainly of the boys reported that they had driven a motor vehicle while high, and again this is quite remarkable because most of these boys are either 16 or younger. So motor vehicle includes things like snowmobiles, ATVs, and so forth. One in four had reported arguments with parents because of drugs. For the girls, almost one in four reported arguments with friends because of drugs. Finally, 10% had sought help to reduce drug use.

    We summed up the number of problems, just to give a general idea. These are the previous groups of problem behaviours. What you can see is that the majority of boys and girls reported that they had engaged in at least three of these behaviours, and almost half the boys in four or more. Very few reported that they had used illegal drugs more than five times and had not done any of these things or even just one.

    Then we asked them how often they had used drugs during the period when they were using drugs the most. What we found was that the majority of the boys and the girls reported that they had been using drugs two to three times a week or more, and close to 40% were using four to seven times a week or more.

    In summary, the normative pattern of drug use, which characterizes about one in four of all Quebec adolescents, is the use of drugs two times a week or more, going to school high, spending much of the day high, and use in risky situations such as bicycling, sports, etc. The most commonly used drug is marijuana. It's clearly not true that drug use among adolescents is experimental and limited to occasional marijuana use at parties.

    Why should we be worried? There's a very good book called The Science of Marijuana, which is I think quite a scholarly work by a pharmacologist. He's not a substance abuse expert. He has no particular axe to grind, but he has a very good quote here about the effects of marijuana and memory:

By far the most consistent and clear-cut effect of marijuana is disruption of short-term memory. Short-term memory is usually described as “working” memory. It refers to the system in the brain that is responsible for short-term maintenance of information needed for the performance of complex tasks that demand planning, comprehension and reasoning.

º  (1620)  

    He goes on to talk more about the impairment of memory. I bring this up because we're talking about adolescents going to school stoned or driving motor vehicles or rollerblading, playing sports, and so forth.

    The other thing he brings up is marijuana and dependence:

It is becoming increasingly clear that cannabis is a drug on which regular users become dependent, and that this adversely affects large numbers of people. Cannabis dependence is still largely unrecognized because it is still widely believed that it is not an addictive drug. There is a real need to educate cannabis users in order to convey the message that they do run the risk of allowing the drug to dominate their lives.

    We have some concerns. What effect will going to school high have on educational attainment? We don't know. Will use in risky situations, as is occurring, lead to injuries? We don't know. Does the rapid progression from first use to frequent and pervasive use represent dependence? Remember, we're talking about 15- to 16-year-olds who have only started using cannabis quite recently. We do have a CIHR-funded grant and a follow-up in progress to address the above, but we'll have results in about three years.

    Finally, development and drug use. Adolescence is a critical period for development. What does it mean for learning peer relationships and independence if you're spending much of your time stoned?

    Why is there such heavy use of marijuana among adolescents? I'll switch to some other data. This is from the Ontario student drug use survey. I will just make the point that the frequency of use of cannabis and hallucinogens has increased over the last decade. We're not looking at a stable picture.

    These are somewhat different figures from what I showed you, but they are comparative figures because they use the same way of assessing data in the two different time periods. You can see the use of cannabis and hallucinogens has roughly doubled or tripled.

    Secondly, marijuana has become more potent, more available. According to the RCMP, about half the marijuana used in Quebec is grown locally, often indoors. Two decades ago, most was imported. It's also become more potent--again, this is from the previously mentioned book. I think you've had testimony on this. The THC content has gone up considerably in the last few years, so we're talking about much more potent marijuana.

    The perception of harm and availability has changed. Again, this is from the Ontario student drug survey, and it compares 1991 and 1999. You can see that the proportion of students thinking there's a great risk in smoking marijuana has decreased, the disapproval of smoking marijuana regularly has decreased, and the perception that it's easy or very easy to obtain has increased.

    Marijuana is perceived by adolescents as already decriminalized. Adolescents perceive that the police are more tolerant of cannabis than alcohol. It's smoked and sold openly in public. This is a nice quote from the Montreal Gazette in December of last year:

Police at downtown Station 21 figured something was amiss when tourists began walking in to ask whether Canada had legalized drugs like marijuana and hashish

It's believed by adolescents that prosecution and legal consequences for use are now rare.

    Decriminalization is perceived as indicating no harm. Adolescents tell us that what they read in the papers as well as statements by the Canadian Medical Association, the Quebec government drug abuse agency, and the federal government with regard to decriminalization are perceived basically as health endorsements. Similarly, the medical marijuana debate has led to the perception of marijuana as a healthy drug. The reasoning runs something like this: the government is growing cannabis, so it must be good, and cannabis helps people who are sick feel good, so it will make me feel good too.

    There's the absence of any message that marijuana has problems. Most coverage of marijuana in the media, in my opinion, is relatively positive. There really aren't any significant statements from Health Canada, the Quebec government, CMA, etc., on possible problems related to marijuana and adolescents.

    To summarize, we have an absence of effective control of cannabis through the criminal justice system; increasingly potent and cheaply available marijuana; an effective, whether intended or unintended, campaign to promote the use of marijuana; and a complete absence of social--that is, non-police--controls on use by adolescents. You can compare this with tobacco and alcohol, where it's legal but we have laws on use by minors. We have campaigns by Health Canada, the provincial government, etc., to discourage either first use, such as tobacco, or inappropriate use, such as alcohol. I think there is no justification for marijuana to be the one drug that is legal and socially acceptable for adolescents.

º  (1625)  

    I want to make two points about hallucinogens, which are the second most common drug. They're often ignored in the discussion of drug use, and they're generally not a major cause of seeking drug treatment. They are dangerous. The most common hallucinogen actually taken is phencyclidine. It's a major cause of psychosis and violence in adolescents. It's difficult to treat. It can lead to long-term psychotic illness. It can also be fatal. Ecstasy also leads to psychiatric emergencies, and it can also be fatal. There's very good work being done on this in Toronto.

    In conclusion, I think the very special needs of adolescents must be taken into account when deciding drug policy. The policy for adults will not be the same as that for adolescents. We're talking about adult versus minor status. There are different drugs used and different patterns of problems. We need to think carefully about marijuana given these and other recent findings. The question is not should marijuana be decriminalized, but rather how should we as a responsible government reduce the harm associated with marijuana and any other drug?

    I have one recommendation. The drug policy is too complex to be just simply legislated. You really should consider creating a government agency whose mandate would be to reduce harm from drug use. This would not be a law enforcement agency. We should develop, test, and implement best practices for reducing harm from use or even first use. When I talk about reducing harm from use, that can certainly include discouraging people from use. Finally, we should monitor drug use over time and provide an accurate picture of drug use and dependence in Canada.

    Thank you.

º  (1630)  

    The Chair: Thank you, Dr. Zoccolillo.

    You said that hallucinogens are dangerous and that the most common hallucinogen actually used is phencyclidine. What about mushrooms and LSD?

    Dr. Mark Zoccolillo: When people have done studies of the pills people take, or even if they take mushrooms, generally speaking it's phencyclidine and/or amphetamine, because that's what's easiest to manufacture. LSD is hard to make, as are many others.

    The Chair: What's the trade name?

    Dr. Mark Zoccolillo: Phencyclidine goes under angel dust, wack, any number of things.

    The Chair: That wouldn't actually be the trade name. It would be the common name.

    You mentioned comments from the federal government. What specifically were you referring to?

    Dr. Mark Zoccolillo: I'm talking about what adolescents tell me with regard to their perceptions of drug use. They say things like “The government is growing it, they're paying for it to be grown, therefore it must be good”.

[Translation]

    The Chair: We now have a little time to ask questions. If Mr. Ménard puts a question to someone in particular, but others wish to answer it, please let me know. If the questions and answers are brief, we will be able to ask a number.

    Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Are we sitting until 5:00 p.m. or 5:30 p.m.?

    The Chair: It should be until 5:00 p.m. Can we sit until 5:15 p.m.?

[English]

    Mr. Mac Harb (Ottawa Centre, Lib.): I have to leave at 5. But go ahead.

[Translation]

    Mr. Réal Ménard: Approximately how much time did you want to give each member?

[English]

    The Chair: Do you have to go at 5?

    Mr. Derek Lee (Scarborough—Rouge River, Lib.): I can't commit at this time.

    The Chair: So right now we're here until 5. I didn't even check with our witnesses.

[Translation]

    Mr. Réal Ménard: Roughly 10 minutes per member?

    The Chair: Yes.

    Mr. Réal Ménard: All right.

    First, when I was elected in 1993, one of the first persons I met who spoke to me about the harm reduction strategy--I'm not saying that to make her seem old because she looks as young as she did in 1993--was Dr. Morissette. In my neighbourhood at that time, there was a very important debate going on that divided the community and concerned the idea of establishing a needle exchange site. The members of this committee have visited one of those sites. I say this so that you will know about it, Carole. We went to visit the Dopamine people.

    I'll ask you the first question; and I'll put others to other people after that.

    From what the witnesses say, Montreal is a city that is probably different from other cities. There are indeed a lot of intravenous drug users. What is quite troubling is that, despite the fact that this has been the case for a number of years, you say that public authorities have never managed to finance studies that would enable us to understand the rights or passages or customs--I don't know what word would be the most appropriate--as a result of which people begin to inject drugs.

    Did I understand the meaning of your testimony this afternoon?

    Ms. Carole Morissette: In fact, what I said today is that we do in fact have a population of intravenous drug users in Montreal, as we do in other Canadian cities, and that, among young street people, there is a well-documented phenomenon of passage to intravenous drug use by this cohort of young street people conducted by my colleague Dr. Élise Roy. This is one of the only cohorts in which we can really measure the passage from other drug use to intravenous drug use. So it must be seen that this is in the context of multiple substance abuse: these people are using a number of drugs. So we are able to measure and observe the passage to intravenous drug use. The data are quite comparable to what we find in certain American cities where this type of study has been conducted.

    So what I'm trying to say is that this is a disturbing situation since it means that more and more individuals are injecting drugs, although we don't have a very good idea how many, since our studies on the population of intravenous drug users date back to 1996. They are really studies that must be redone in order to assess the situation clearly. We are not entirely up to date on the situation. That's what I also said.

    As to solutions, I can tell you that very little is said in the international literature about how to prevent the shift to injection in societies and among young people who switch to this type of drug use. This is an era of development which is not restricted to Montreal; it's international. It's a question that arises for health stakeholders and governments wishing to know how to respond to the situation, which could become more widespread and is definitely very disturbing. Research is also currently being done by Dr. Élise Roy's team, who are trying to ascertain more clearly the determinants of the passage to injection. These are both quantitative and qualitative studies, which are thus conducted by means of in-depth interviews. We hope to obtain certain potential solutions, but we are also aware that this is a long-term effort, which will enable us to get a better idea and will probably allow us to design a pilot project that will have to be evaluated in order to determine whether we can reduce this problem in our Canadian cities.

º  (1635)  

    Mr. Réal Ménard: All right.

    So it might not be a bad idea to invite Dr. Élise Roy. I know we have a lot of witnesses and that we will have to meet in August. Thank you.

    I now move on to your colleague. The conclusion to your document from Dr. Erickson is ultimately quite contrary to what most witnesses have told us. Even the Senate Committee, in its discussion paper, cites three scientific references which contend the contrary.

    First of all, as a doctor, as a professional, do you share the idea that cannabis causes dependence? In fact, to be more clear, the following distinction was made. It was said that cannabis does not create physiological dependence in that, for example, no one can take an overdose of cannabis. One cannot be that dysfunctional. Our bodies cannot demand that much, unlike other types of drugs. However, it can create psychological dependence. For example, some people can anticipate the entire day from the moment they find themselves in front of the television smoking a joint in the evening. This distinction was often made between physiological dependence and psychological dependence. In Dr. Everson's conclusion, this distinction does not appear to be made.

    What do you think of that distinction? I imagine that, if you put it in your brief, you must agree with it.

[English]

    Dr. Mark Zoccolillo: First of all, there's the criterion for dependence of the American Psychiatric Association--which is the standard criterion--which is the diagnosis of dependence. It incorporates but doesn't necessarily mean the physical dependence. So it depends. If you want to adopt a standard diagnostic criteria that's used by physicians for diagnosing drug dependence, then cannabis has rates of drug dependence that are not terribly different from other drugs.

    If you want to talk about dependence leading to physical withdrawal symptoms, you don't really have that much either with cocaine. You have intense craving on withdrawal from cocaine. In that sense, you have psychological dependence.

    Similarly with nicotine in cigarettes, the physical withdrawal symptoms of nicotine are trivial. The craving is severe. To me, this idea that somehow you're talking about physical versus psychological is not something terribly interesting.

[Translation]

    Mr. Réal Ménard: What are we as a committee to understand? Are we to understand that cannabis results in dependence just like other drugs and that no distinction should be drawn between psychological and physical dependence?

[English]

    Dr. Mark Zoccolillo: It's not a relevant distinction as far as psychiatrists and people who treat drug dependence are concerned. It's a distinction that is simply not relevant.

    Dependence is defined in a particular way by the American Psychiatric Association, and it is clear that people who smoke marijuana heavily become dependent, that people who try to stop smoking marijuana develop psychological symptoms of feeling unhappy and ill at ease, and that they want to go back and smoke marijuana. They have trouble stopping. They continue to use it, despite wanting to stop and despite having problems from it.

    I should also point out that there is much newer data now that contradicts the Senate report. For example, there is at least now one animal model of cannabis self-administration.

[Translation]

    Mr. Jean-Sébastien Fallu: According to the APA definition, one can develop dependence on any substance. I find the distinction between physical and psychological dependence interesting, but it is true that, like alcohol, tobacco, legal and illegal drugs, all substances can result in dependence as defined in accordance with the DSM criteria.

º  (1640)  

    Mr. Réal Ménard: I think the distinction is relevant too. It is cited by virtually all the witnesses who have conducted studies on it.

    You didn't say much about the legal framework concerning your study. If you had to tell us a few words about the legal framework... For example, I believe it is quite clear that, in Dr. Morissette's view, prohibitionist strategies do not enable us to intervene adequately with street people. Do you share a view such as that?

[English]

    Dr. Mark Zoccolillo: I think the issue with adolescents is if you're talking about making marijuana legal for adolescents, you give it a status that you don't give to alcohol or to tobacco.

    In regard to the discussion of decriminalization or legalization, first, as I pointed out, as far as adolescents in Quebec are concerned, it's been decriminalized. It's an irrelevant discussion for them. Secondly, as far as adolescents are concerned, even if you made it legal, it would be difficult to imagine that marijuana becomes the one drug legal for adolescents when all other drugs are not.

    So I would say you have to think of adolescents as a separate group, whatever your recommendations are for decriminalization.

[Translation]

    Mr. Réal Ménard: With regard to your sample, I understood from the start of the description of the sample that there were 879 boys and 929 girls. So it's an interesting cohort of high school students. Should any distinctions be drawn, for example, based on socio-economic considerations, or are these people from a fairly homogeneous background?

[English]

    Dr. Mark Zoccolillo: It was a sample that was to be representative of students entering francophone school boards in kindergarten, and we followed them up to age 15. So they are pretty much representative of the population of Quebec. They had the same range of socio-economic status and were from rural school areas and urban school areas. It was quite representative. The differences between those who were using drugs as described, the one in four, and those who were not were not terribly different on either socio-economic status or behaviourial problems, or any of the other usual indices.

[Translation]

    Mr. Réal Ménard: Do I have the time to ask one final question?

    The Chair: No. I tried to interrupt you earlier.

[English]

    Mr. Mac Harb: I was quite interested, Mr. Zoccolillo, in your presentation on the effect of marijuana on youth, and whether we like it or not, it's true. But in your view, isn't it also true that tobacco as well as alcohol also have a devastating long-term effect on youth health? In the case of alcohol, it does have an immediate effect too. If you abuse the level of alcohol you have taken in, you have an even shorter level of memory, I would presume. Wouldn't that be the case?

    Dr. Mark Zoccolillo: Yes, but one of the things I didn't point out, because I didn't have time, was that these adolescents who were smoking cannabis also reported that they drank alcohol but they didn't to go school drunk. They limited their alcohol to once a week, on average, they didn't drink in the morning, and they didn't ride their bicycles and so forth to any extent. So there's quite a specific way of using cannabis here; that is, even when you take those who are just using alcohol and cannabis.

    Mr. Mac Harb: I guess the correlation I'm trying to establish is that in terms of harm--looking at harm to youth in this case--whether it's alcohol or drugs, in a sense, both are harmful.

    Dr. Mark Zoccolillo: My guess is yes, they are. It is harmful to be going to school stoned; that will be found to have an effect.

    Mr. Mac Harb: Or drunk.

    Dr. Mark Zoccolillo: Right.

    Mr. Mac Harb: The issue we're struggling with, because we have one of our colleagues who has referred a private member's bill to this committee as a result of a Parliament of Canada decision to pass it on to the committee, is whether or not at the end of the day we should or should not address the whole issue of decriminalization.

    Under the present circumstances, if the police were to apply the law, we would probably have a lot more youth behind bars than we do. The way it is now, they have an attitude that almost says, look, we're not going to put somebody in jail just because that person has half a gram of marijuana; it doesn't make any sense. We would be turning somebody into a criminal for something 30% or 40% of youth are experimenting with in any event.

    Is it your opinion that there should perhaps be some change to the law, so that law enforcement officers would not be finding themselves in a situation where they're doing something the law as it is right now may not give them a way to do?

º  (1645)  

    Dr. Mark Zoccolillo: Yes, and I think what we would do is be in the situation we were in with tobacco 30 or 40 years ago, where it would be quite easily available. It would probably be sold by cigarette companies. We would have very high rates of use, and then after a period of a decade or so we would realize that we need to put in other social controls because there would be all kinds of ill effects.

    That's where we are now. We don't have either. We're avoiding the criminal sanctions, but we've not put in place any effective social system to control the use of cannabis. We have to substitute something better than the nothing we have now. Now what we have is a sort of free and open market.

    Mr. Mac Harb: I suppose you will couple that with some sort of a national campaign, creating awareness, talking about the potential harm. Would you do that, or would you do it in isolation?

    Dr. Mark Zoccolillo: Certainly, I would consider a national campaign. But I would suggest creating an institution or a government agency that can look at all the available data to say what the best approach to trying to reduce harm would be and then test it. Quite often, we think we know what we're doing, but we don't. It's better to test it and change our approach.

[Translation]

    Mr. Mac Harb: Dr. Morissette, do you have any comments to make on what Dr. Zoccolillo has said?

    Ms. Carole Morissette: I should say that my thoughts on cannabis are quite limited. I have not extensively studied the question of the effects of cannabis use on health or that of its effects on society, but I am very much aware of it and I find it interesting to see the data on the situation of drug use among youths.

    First, we must really monitor the evolution of drug use in the population. We must really have research that gives us a very clear idea of what's going on. We see there is an increase in drug use among young people in the schools and young people in the streets, and they're using all kinds of drugs, not just cannabis.

    I can tell you that we recently identified a very recent increase in the use of crack among young street people, and we have no idea why.

    Having said that, I believe we must know and understand better why youths in our society need to use more drugs and use them more often. I believe we have to answer a certain number of questions and determine a certain number of solutions and follow them.

    I don't believe that enforcement is a solution, certainly not among school-aged youths, but I agree it is very important that the population be informed of the effects of drugs. I believe this is something we've forgotten, in spite of everything. There really has been very little investment in youth education programs and in drug information and other things because we know perfectly well that teenagers are tempted to experiment with many situations. I believe we should put a little more emphasis on notions of education. Here again, we could have a debate on how to bring up young people.

    I'm not going to get started on that, but I truly believe that it's a very important point to know how to provide a framework for education programs on such controversial matters.

    Mr. Mac Harb: Thank you very much. Mr. Fallu.

    Mr. Jean-Sébastien Fallu: We have to be very careful about drug education. Yes, we have to inform people about the risks of drug use, because there are risks, but we have to watch out. Studies on prevention programs show that, when we try to scare or create anxiety, not only is it not effective, on the contrary, it aggravates the situation because it discredits everything we tell young people, particularly when it goes against their own experience.

    Furthermore, it's not a majority of young people who are having problems. So if we begin to scare them and create anxiety, that doesn't work.

    The Chair: Does anyone else want to add anything?

[English]

    Dr. Peter Vamos: For me, the preoccupation is a little bit like what Dr. Morissette said. Why is it that more and more kids are turning to drugs? What need is the drug filling, and can we help them fill those needs in some other way?

    For me, focusing on the legal status of drugs is missing the point. I think that's a question of community standards. I think more important is the problem that addicts or habitual drug abusers have and how their needs can be met in more adaptive ways.

º  (1650)  

    The Chair: Dr. Morissette.

[Translation]

    Ms. Carole Morissette: There's another concern that must be considered. It's a delicate matter because it's not a field that I know very well, but there are nevertheless a lot of drugs on the market at the present time; many street drugs are available. New drugs are regularly offered at increasingly reduced prices. I believe that, in designing a drug strategy, we must nevertheless admit that we are coping with a situation in which there is a very high degree of social marketing in order to provide the public, particularly young people with a host of drugs at reduced prices.

    In that context, I believe we should consider how we inform and educate the public, but also what we should do about the quality and availability of those drugs. I believe that the entire question of the legal framework and decriminalization must be viewed in this light.

    Incidentally, I will say that heroin clearly has not been as readily available in Montreal in recent years, but I can tell you that, at the very start, 10 years ago, heroin was much more expensive than it is now. It is not unusual for street youths to say that, from an economic standpoint, heroin is more readily available on the street than beer at a convenience store. So I believe that raises some questions about this factor of ease and availability.

    The Chair: Yes, of course.

    Mr. LeBlanc.

[English]

    Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.): Thank you, Madam Chair. I thank all of you for your presentations. It's interesting to hear the different perspectives and the cumulative experience that all of you have.

[Translation]

    My colleague Réal said it well: we spent a very pleasant and very interesting evening in his neighbourhood, at Dopamine. It was my first time. I believe it was one of our first visits. So it left a mark on me. I very much appreciated the candor of the people who were there. It taught me a great deal. With your permission, I would like to ask Dr. Morissette a few questions.

    There is a lot of discussion, particularly in Vancouver and, I imagine, in other large cities, about the need for safe injection sites. In Vancouver in particular, we were often told that. Based on our experience and your testimony, I get the impression that there may be a need and a desire to explore the situation, whether in the context of a research project or to better understand the dynamic in certain contexts.

    How do you view the entire question of having safe injection sites? I should tell you that I don't really see how we can sell that to the entire country, particularly in a rural area such as mine. It's not easy to explain to someone on a fishermen's wharf in New Brunswick that there's something safe about injecting drugs. So you often have to find the right word. I have no set idea on this, but I would like to hear what you have to say, in view of your experience, because I believe we have to address this kind of question.

    Dr. Morissette, I believe that you are right about the need to revise laws and to consider the legal context. I wondered whether you had any specific suggestions about the context or certain examples that you might have had in mind when you talked about revising legislation.

    There's something else on which I entirely agree. You spoke about the need for community leadership or health leadership. This entire question has made me really understand that health issues are often not sufficiently considered.

    How do you view the federal government's role? Particularly in Quebec and perhaps in Alberta, when the federal government decides to get involved in taking a leadership role in health, particularly in the community area, where federal-provincial jurisdictions complicate matters. So as a federal government, how, in your view, could we support your efforts and those of your colleagues without having run-ins with the provincial governments? Yours and that of Alberta are those that react the fastest, but there are others. So how do you view the federal government's role in this context?

º  (1655)  

    Ms. Carole Morissette: I'll start by answering the last question, and then, if I forget the others, please repeat them to me.

    I believe I was clear in saying that public policies have an impact on health. In coming to see you, I considered what impact the federal government could have on major cities such as Montreal. I believe the impact is great.

    I'm not an expert on finance, but I think the committee must have considered the status of public finances in terms of enforcement as opposed to health in the field of drugs. I believe the parent data should be examined and could provide a clearer response.

    In addition, I spoke about public policies on employment, education and housing. There's really a great deal of work to be done. There is systematic discrimination against persons who are socially disadvantaged, and they are the ones who experience the main problems related to drug use, but also against drug addicts. It is very difficult for a person with a drug addiction background to return to society. Existing policies do not favour social reintegration and, in my view, the government should examine those policies.

    When I mentioned community health, it was in a broad sense. Thus I'm thinking about public policies and the legal framework. In my opinion, efforts have to be made across the country. I have no ready-made solution, of course, and, since I'm not a legal expert, I also haven't examined the question of how legislation could be amended. I can only observe the consequences for health and programs.

    I believe an effort should be made so that qualified people can work together to determine ways to review the legal and regulatory framework. Efforts should also be made to ensure that the various levels of government, including probably the municipal level, determine how to develop and implement prevention programs that actually enable users to benefit from them and make it possible to measure their effects on health.

    I believe I've answered your last question.

    As for the other questions, I agree with you about the term “safe injection sites” in Canada. There is a bilingual document on the Canadian Legal Network which is very well done. I invite you to read it. It's very instructive.

    I believe the word “safe” can be confusing because, indeed, no drug injection can be characterized as safe. When you work in HIV and Hepatitis C prevention, you tend to talk about “reduced risk injections”. This is the notion of risk reduction, precisely so there is no confusion.

    The objective is to ensure a higher degree of safety for drug addicts who have to inject, in the sense of medical supervision. So it must be clearly understood that we're talking here about places where there is supervision, not assisted injection. This is really a service for drug addicts which is part of a set of services. None of the people who promote these projects and programs thinks that this could be a service outside a range of services. In the general view, there must necessarily be a set of health and social services to help drug addicts get by, but also to enable them to improve their living and short-term health conditions.

    So, when I think of a set of services, that includes needle exchanges, of course, but also medical services and access to detox services and rehabilitation services. Sometimes it also includes housing and emergency support services as well as psychiatric assistance to reduce suicide risk among people with mental health problems and so on.

    Mr. Dominic LeBlanc: Thank you very much.

    We also heard a lot about the heroin maintenance programs, in which there will be a doctor, if I understood the people who told us that, who will give prescriptions for heroin. I'm not talking about methadone, but about heroin as such. Do you see a benefit in that? Would that be something to consider?

    Ms. Carole Morissette: I think it must be considered. There is a peer review committee, I believe, that found it was relevant to Canada to conduct a clinical trial since that clinical trial was accepted at the Canadian Institutes of Health Research. Clinical trials of that type have also been done in Switzerland and some are currently being done in Australia. The clinical trials in Switzerland have proven their worth. The Swiss population also voted in a referendum and approved the inclusion of this type of program in their health program.

    At present, it can be said that there is an exemplary research plan which is being done in Australia and will be done in Canada to give us a good idea whether it would be relevant in the Canadian context.

»  (1700)  

    Mr. Dominic LeBlanc: Thank you very much.

[English]

    The Chair: Merci beaucoup, Monsieur LeBlanc.

    Dr. Zoccolillo, you interviewed the students about a number of ways their alcohol or drug use has social impacts. I noticed that you didn't include sex.

    I know that when we had Dr. Christiane Poulin here, she talked about that high-risk group of teenagers being engaged in some pretty risky behaviour, and sex is part of that. Of course, that this group is more open to unsafe sex and therefore open to other illnesses is of concern. Is there a reason you excluded it, or is it that you have enough problems of anti-social behaviour on your plate already?

    Dr. Mark Zoccolillo: Other people have asked us that too. We just happened to have so many questions we could ask. We had a separate section that asked about sexual behaviour. In our adult follow-up we will be looking at sexual behaviour and questions related to this issue. It is just a matter of how many questions we could put in there at the time.

    We also weren't sure how we could really ask these questions in a self-administered interview in a way where we would be able to get at what was interesting.

    The Chair: There were for me a couple of startling differences in your numbers. That's where the difference between girls and boys in terms of.... The argument with friends because of drugs is more common with girls, and boys are driving motor vehicles when they're high. Were there any explanations around why those--

    Dr. Mark Zoccolillo: My guess with respect to motor vehicles is simply that there are more boys driving ATVs and snowmobiles or driving cars even when they don't have a licence than girls. They drive motor vehicles, so they have more opportunity to drive while stoned.

    My guess with regard to friends is that it simply may be that the girls' friends get more concerned about their drug use than the boys, but that's just speculation.

    The Chair: Dr. Vamos, when we were talking to people in different parts of the country, they were extremely concerned about the lack of treatment facilities that are available. In Vancouver we heard there were six treatment beds for adolescents, yet there is a serious problem with crystal meth and very much so with heroin. Even in Saskatchewan, with a much smaller population in total, they were concerned they only had 12 beds, which frankly would look good in Vancouver.

    Are there adequate treatment facilities, or is that part of the continuation of the problem for a lot of people who would like to seek help?

    Dr. Peter Vamos: There are probably not adequate treatment facilities anywhere in the country, certainly not on the west coast. We are in very close contact with the City of Vancouver, and the City of Vancouver is struggling right now to address the problem.

    The situation became even more complicated when the federal government passed the law enabling conditional sentencing by the courts. This was going to facilitate the courts' referring addicted offenders to treatment across the country. Even though the legislation is on the books, the judges are expressing great frustration to treatment providers because there are not enough treatment slots to accommodate these people. There are precious few in the parts of the country you're talking about.

    We are making a lot of very progressive moves on an ideological level, but unfortunately, on the practical side we're lagging behind.

    The Chair: One of the things some committee members might be interested in is tying transfers to the provinces to the creation of treatment beds. And it's not just beds. In Saskatchewan there was a lot of talk saying, please, don't get caught up in just beds, there's a lot of outpatient treatment that can be done. Would you see that working? Do you think that would help other provinces that have already taken care of the problem and that wouldn't be interested in that?

    We heard that in the United States they felt pretty confident there were enough private insurance plans that would pay for these things. Are there private insurance plans in Canada that are picking up the slack for people who can't afford to pay for facilities, or is this a population that often doesn't get medical coverage because they're not employed?

»  (1705)  

    Dr. Peter Vamos: I think, Madam Chairman, the last place on earth we should look to for solutions for this problem is the United States. With the introduction of HMOs in the United States, it's almost impossible to get adequate treatments. They have reduced funding of treatment agencies to an absurd degree, whereby most people who are relying on HMOs to secure treatment for themselves or for their families are not getting the treatment they need.

    I think there are very strong economic arguments for treatment. The famous Caltech studies in California show that for every dollar spent, $7 is saved by society in treatment.

    I think it's a question of refocusing or reorienting our priorities.

    We have believed for a long time that it was possible to conquer the problem of drug addiction or the problem of substance abuse.

    I think we are coming more and more to terms with the fact that the only way to deal with substance abuse will be to eliminate the demand or to severely reduce the demand. That really involves treating the people most in need of treatment and not imprisoning them.

    In addition, the United States has the highest rate of incarceration in the world, and I don't have to tell the committee this. There are more people incarcerated there than there are in China. Two million people at last count are behind bars, and more than half of them are there for drug-related offences.

    So I wouldn't want to use them as our role models.

    The Chair: Is there among treatment providers enough of a network of services? One of the things that concerns me is that this is a life-long illness for many people you would see. Not all of them need to go into a 28-day program or a two-month program all the time. Sometimes they just may need a fill-up, a short, sharp stay to reinforce the messages or whatever. I guess a fill-up isn't a very good example for people who have substance problems.

    The concept that there need to be different types of treatment and that governments should be providing this, so that we don't end up leaving someone who has done really well but who has a short relapse...that they can get help quickly.

    Is there enough of a network? Are there things missing from the network? And could the network tell us how to design a program for Canadians? There seem to be some serious differences right across this country.

    Dr. Peter Vamos: In 1974, when I started in this field, there were, I believe, nine provincial commissions on substance abuse that had, as part of their responsibility, to ensure that there were policies and networking possibilities.

    Quebec had OPTAT. Almost every province had an organization responsible for that.

    Other than Alberta and Manitoba--and I don't remember whether Saskatchewan still has one or not--there are none left.

    The Canadian Addiction Research Foundation, which was federally supported and which had the responsibility of bringing treatment providers and researchers from across the country together at conferences and study sessions, lost its funding somewhere in the past. Over the last 30 years the field of addiction has taken a lot of retrogressive steps.

    I'm delighted that you're asking the question, because the need is tremendously severe. I think someone will have to take leadership. I believe the leadership will have to come from the federal government.

»  (1710)  

    The Chair: Between when I first met you on the justice committee and now, I've been sitting on the environment committee. It always seems to me that this is a similar problem. You have to turn off the tap; you can't just keep cleaning up the river. You also need to make sure that you're giving people some options for getting healthier or we'll never solve the problem.

    Certainly, Dr. Zoccolillo, the messages people are not getting, contrary to the messages they are getting, is problematic. Are you working at all in terms of trying to help design effective messages to young people? Clearly, if they're thinking that marijuana is safe because governments are involved in this.... I wouldn't recommend that people take morphine, left, right, and centre, or aspirin, left, right, and centre, yet those are approved by the Department of Health as well.

    People understand in other areas that there are medicines or substances that help you through something.

    I wouldn't be taking insulin, which is a drug as well.... Clearly people who need insulin should be getting insulin and the government's approval of that.

    On the messages on marijuana, they seem not to be understanding the subtleties of it. Are you doing any work in the messaging area? Do you have anything to point to that we can help suggest the government communicate with kids?

    Dr. Mark Zoccolillo: First, I think there actually needs to be more research on this whole issue of what influences adolescents' perception of drug use. This is only sort of anecdotal evidence from the adolescents we talk to in trying to understand why we have this upsurge in use. But I should also point out that unlike any other medically approved drug, there's no medically approved drug where the government has said, “If you go and ask your physician for it and say you need it, and as long as he or she gives you a prescription, you can go and get it,” which is the situation now with the proposed or actual laws regarding cannabis as a sort of semi-medication. So there is a special status for cannabis that's even different from medically prescribed drugs like morphine or any other drug.

    The Chair: How do you figure? If I want a prescription for Dilaudid to deal with my pain, I go to my doctor and--

    Dr. Mark Zoccolillo: No, you go to your doctor and you say, “I have a particular problem with pain.” The doctor says “These are the options” and prescribes it. Under the current situation, somebody says “I need cannabis”, period, and then the burden is put on the physician to prescribe it. It is different. There is no question that cannabis has been given a different sort of status here.

    The Chair: With respect, I absolutely disagree with you. Sure, some people might be walking into their doctor's offices and saying “I would like this.” Lots of people are reading advertisements in American magazines and saying “I'd like Viagra”, but that doesn't mean a doctor is automatically forced to give something to people. If a patient presents, surely a doctor would say “Let's look at the other options before you take marijuana. Before I write this prescription, I have to see (a) do you have pain and (b) what are some of the other solutions.”

    Dr. Mark Zoccolillo: The point is that there are no particularly accepted indications for cannabis use.

    The Chair: In Atlantic Canada we heard all about Dilaudid use. Frankly, there are probably some indications, but it seems there are a lot of doctors prescribing on very little information, and that's a fairly heavily controlled and fairly strong narcotic. How do you see that as any different from marijuana?

    Dr. Mark Zoccolillo: There is a good body of evidence for pain control with Dilaudid. The body of evidence for cannabis is certainly not yet in.

»  (1715)  

    The Chair: Fine.

    Dr. Mark Zoccolillo: Second, the active ingredient THC has been available for prescription for many years and is not used because there are better medications for a variety of things.

    What I do want to point out about the medical aspect of it is, apart from those who are really convinced that there is a legitimate medical use for it--and I think it's fine to do research on that, and I have no problem, if it turns out to be medically useful, that it should be part of a physician's armamentarium. It should be pointed out that part of the reason for this push behind the medicalization of it is the whole idea of eventually making it legal.

    I think that is part of the message that adolescents are getting. It's part of the way of making marijuana a legal substance that many people would like to use. Again, I think that is part of the message that adolescents are getting.

    The Chair: Part of whose program? You said it's part of a program to get marijuana legalized, but part of whose program?

    Dr. Mark Zoccolillo: There are a number of groups that would like marijuana legalized, decriminalized. I believe the Marijuana Party testified or came here and talked with you.

    The Chair: Yes, but that certainly isn't, I believe, the impetus for the medical use of marijuana. There is anecdotal evidence--

    Dr. Mark Zoccolillo: I'm saying that part of the reasoning behind the medical use of marijuana, I think, has to do with wanting to have it legalized, and that is part of what is also behind the message that adolescents are getting: medical use equals...that it is something that is good for you.

    The Chair: I agree that kids are getting that message and it may be confusing to them. And it's surprising. I'm also surprised by how many youngsters don't realize there would be a threat of lung cancer by smoking anything, inhaling anything. But I'm not sure the federal government's initiative on the medical use of marijuana is about legalizing it.

    Dr. Mark Zoccolillo: I think it should be looked at. I think it should be clearly looked at to determine whether that is contributing to adolescents' use of cannabis. I would fully agree that it needs to be looked at by research, and I may be proved wrong--

    The Chair: I think we have to do the evaluations, because, frankly, if it's not working, we shouldn't be prescribing it for anybody. So I agree with you on that.

    I have Mr. Lee.

    Mr. Fallu, do you have a comment?

[Translation]

    Mr. Jean-Sébastien Fallu: No.

[English]

    Mr. Derek Lee: Well, I was going to engage in a bit of discussion with Dr. Zoccolillo on this issue of whether or not the medicalization of marijuana--or medical marijuana--was somehow an inducement to some people to smoke it. I could be wrong, and maybe we should track it, but I'm going to doubt that the initiative to make marijuana medically available is going to produce much of an upsurge in the data on consumption.

    The data on consumption of marijuana among youth is already way up there--25% to 30% or higher. A lot of youth experiment with, consume, try, smoke marijuana--and that's in the face of prohibition. That is in the patent face of total prohibition that we have such a high percentage of our youth, and other portions of the population, using marijuana.

    I appreciate your thought that there may be factors that contribute to this high degree of use, but please reply to my suggestion on your suggestion that the government decision, responding to a court decision to allow medical use of marijuana, is a major factor in those relatively high consumption statistics.

    Dr. Mark Zoccolillo: First of all, I'm not saying it's the only factor, but what I am saying is first we have to look back ten years to when the use of marijuana was much lower among adolescents. That much is clear. There is ample data on it. It has now more than doubled in the last decade--in fact, it more than doubled in the last six or seven years.

    So the question comes up, why is it going up again? When we talked to adolescents who smoke up, one of the things they tell us is that they read in the paper that it's used medically, and therefore it must be good for them. But I can give you actual data from a study in Ontario where they interviewed adults--a large, random sample of adults in Ontario--and asked them about their marijuana use. They found those young adults who smoked marijuana, relative to others who didn't, tended to be young males with lower levels of education who were also more likely to report cocaine use.

    But among that group was a subgroup who reported that they were using marijuana for medical purposes. And that group was even more likely to be young, male, to use cocaine, and to not be well educated. These are not the kind of people I've been hearing about who need medical marijuana. Therefore, there is evidence that this is going on, that this issue or debate over medical marijuana is, however you want to look at it, contributing to the social acceptance of marijuana, particularly among young people.

    There are no negative messages about marijuana out there. I would disagree with you that we have true prohibition; we don't have that. We have tolerance now, even though the law may still be on the books. That much is clear. The courts have said it. We know that for simple use there's very little that happens in the courts, at least in Quebec.

»  (1720)  

    Mr. Derek Lee: Sorry, just what exactly have you heard the courts saying about the possession or distribution of marijuana?

    Dr. Mark Zoccolillo: The police don't prosecute and the courts do very little for a simple use offence in Quebec.

    Mr. Derek Lee: No, you were suggesting the courts had a view here that was somehow contributory to social attitudes.

    Dr. Mark Zoccolillo: No, no, I'm just saying the courts--

    Mr. Derek Lee: I'm curious about what the courts were saying in terms of--

    Dr. Mark Zoccolillo: But I'm saying we don't have prohibition any more in the sense that adolescents no longer see any of their classmates going to jail or having any consequences for smoking marijuana. They tell us that the police see them and ignore them or take their marijuana. They say they know they get in more trouble now when they are seen with alcohol.

    Mr. Derek Lee: This may reflect the degree of social acceptance of marijuana.

    Dr. Mark Zoccolillo: And acceptance by the police and the courts.

    Mr. Derek Lee: And by society.

    Dr. Mark Zoccolillo: That may well be. But we shouldn't pretend we have prohibition now. We don't have prohibition. We have prohibition on paper, but that's all. And I speak for Quebec. I don't know about the other provinces.

    Mr. Derek Lee: Well, in terms of why, that's all you're going to get in terms of prohibition. It's either prohibited or it's not. Whether the people follow the law or not is another issue. However, when I say “prohibition”, I'm only talking about legal prohibition--and when I talk about armed robbery being prohibited, it's prohibited.

    Dr. Mark Zoccolillo: It's prohibited, but if you're caught with it, you'll go to jail.

    Mr. Derek Lee: It's still prohibited, but it still happens. We have a prohibition on armed robbery and we have a prohibition on possession and distribution of marijuana. In the law, you can take that to the bank. However, how many people follow the law is another matter, and that's one of the things you've been studying.

    Thank you.

[Translation]

    The Chair: You may answer.

    Mr. Jean-Sébastien Fallu: I agree with Dr. Zoccolillo: there is also that factor. It's prohibited, but the law isn't enforced. The police themselves admit that they are less and less interested in users. But it must also be borne in mind that we are living at a critical time right now. We talk about positive aspects for changing the law, but unfortunately most people have trouble seeing subtle distinctions: it's either bad or good. We are now in a critical period which, in a way, can encourage drug use.

    In itself, the medical use of a drug is not fundamentally a very important factor in encouraging drug use. Morphine, which, as everyone knows, is used in medicine, will not, like heroin, necessarily be perceived by young people as an inoffensive substance. I don't believe that the medical use of these drugs will encourage them to use them. We are thus in a critical period as a result of which very young people may think these are not dangerous substances, and that can lead them to use them. But we must be prudent and not eliminate all medical use on the pretext that this will only encourage people to use drugs.

[English]

    The Chair: Dr. Morissette.

[Translation]

    Ms. Carole Morissette: In fact, I believe we must bear in mind that drug use is multifactorial and that we cannot neglect any of the factors. I really believe that a study should be conducted on changing social standards with regard to cannabis use and the impact of government policies on those standards. I believe research should also be extended to the other phenomena that may have influenced the adults who are now the parents of those teenagers. That would really be an interesting research question. I am currently aware of a few anecdotal situations in which young people are being expelled from school for drug possession, but where the parents of those youths use cannabis at home and are even the ones who introduced their children to cannabis use. This is anecdotal and only for the purpose of adding to the conversation examples that show that, ultimately, the situation really should be well documented before a conclusion is stated.

    But there clearly appears to be a certain social tolerance of cannabis use, despite the law. I don't think we would agree to imprison 18-year-olds for cannabis possession or use, but we nevertheless have to try to see why social standards are evolving in such a way that a large percentage of young people currently use cannabis.

    Earlier, I appreciated the idea of self-treatment. I have heard about educators in the schools who said that some young people who had taken Ritalin for much of their childhood found that they alleviated their symptoms and were much calmer in class since they had been smoking cannabis and that, in their minds, it was a way of treating themselves in order to be calmer in class. These are also anecdotal elements which absolutely do not constitute a scientific opinion, but which underscore the complex nature of the factors that currently influence cannabis use among young people. That's all.

»  (1725)  

[English]

    The Chair: Thank you.

    Can I just ask one other question? I wouldn't mind hearing from you, Dr. Vamos, about what people are reporting.

    I also wanted to hear from Dr. Morissette. You mentioned cocaine being very prevalent. Cocaine hasn't come up on our radar as frequently as it would, for instance, in the U.S. Do you perceive there's any difference in cocaine use--in Canada or in Montreal or whatever--compared with a comparable American city? Is it the same issue?

    Dr. Peter Vamos: The bulk of our clientele, particularly among adults, are cocaine abusers, and cocaine is a very widely used drug, at least--

    The Chair: In Montreal.

    Dr. Peter Vamos: --among the section of the clients we get, both with adults and with adolescents, and there's a lot of injection of cocaine as well in the population we see.

    I hope there will be a way of separating the issue of the legal status of the drugs from the country's or the individual province's response to the drugs, because the two often are confused to the detriment of both. I think we know for a fact, and the western European nations have shown, that legalizing or tolerating or finding less punitive alternatives neither increases the use nor creates other societal harms. Experiments do not create more addicts. Harm reduction experiments do not damage in any way the social fibre of the society in which they happen.

    There is a tremendous lack in the treatment domain, and I think the reason we're having this discussion--I guess it's now 32 years after the Le Dain Commission--and the reason why Dr. Zoccolillo's statistics reflect tremendous continuing increase in substance abuse is because we haven't addressed the core problem, which is how we are going to respond to the needs of individuals who turn to drugs as a way of lifestyle or as a way of getting through the day. And I think that's an issue that has to be met.

    The federal government, much to my dismay, has been pushed out, in many ways, from taking a leadership role. Canada's drug strategy resides in very small offices in Ottawa. In my province, the province of Quebec, I don't know, frankly, who's responsible for the drug dossier. There's no identifiable group of individuals who take the leadership. I think the same thing is true right across the country.

    Prime ministers in the past who have attempted to take a leadership role were beaten up by the media. So I think there's a real leadership vacuum, which in turn results in a real financial vacuum, and we're casting about for solutions. But I want to emphasize that the issue of the response to the drug problem needs to be separated out from the issue of the legal status of drugs, which is really a societal and a community standards issue.

    The Chair: Merci.

    Dr. Morissette, cocaine?

[Translation]

    Ms. Carole Morissette: Could you repeat the question?

»  (1730)  

    The Chair: When we compare the situations in Canada and the United States, we see that we're always talking about cocaine in the United States, but we don't often talk about it in Canada. Montreal is a bit different from other cities, but is cocaine a serious problem in Canada?

    Ms. Carole Morissette: I believe cocaine is a serious problem, particularly in the eastern part of the country. For some years now, it can be said that cocaine has been a very big problem in eastern Canada, particularly Montreal. For a long time now, 80 percent of those who inject drugs inject cocaine. In recent years, heroin has become increasingly available.

    People use the drug that is available, cocaine, heroin, both. But I believe the profile is changing in Canada. My colleagues in western Canada may have told you that the user profile has also changed in the West. Cocaine is increasingly present, whereas there used to be very little cocaine in western Canada. Instead it was amphetamines and heroin. That profile is tending to change, which is also the case in Europe. I believe you will have the opportunity to see that, in some countries that have begun to implement harm reduction programs, heroin was the drug most often used.

    The evaluations of those countries with regard to harm reduction concern situations where there is a majority of heroin users. Profiles are currently changing, and there are increasing numbers of cocaine users in those countries, as a result of which they have new challenges to deal with in their programs, challenges which we have had for more than a decade. We must try to solve this problem.

    I believe we should work on the treatments issue because it's really a problem, as I said in my presentation. We have a great deal of experience with opiates. We have tried things with opiates and we have substitute products. So we have an offer to make. However, as for cocaine use, efforts really must be made. In a region such as Montreal, where 80 percent of users use cocaine, we have very little to offer the majority of people. An effort really must be made.

    The Chair: In the smaller cities of the country, we have observed a problem of prescription drug misuse. Do we also have that problem in Montreal?

    Ms. Carole Morissette: I'm not completely aware of the latest data, but the list of substances used by street youths and intravenous drug users includes certain prescription medications which are sold on the street, but they're really at the bottom of the list. These aren't the products that are most often used. The drugs most often used are cannabis, cocaine and heroin, which are at the top of the list.

    The Chair: It is very interesting to see that, everywhere in the country, there are small things here and there, but there's nothing else.

[English]

    The convergence is as well, and it's happening faster than we can get our hearings done.

    Do you have

[Translation]

a brief question?

    Mr. Réal Ménard: This committee has heard a lot of witnesses. It has travelled across Canada and is preparing to go to Europe. One of our major frustrations is that few witnesses have presented us studies on personal motivation. I agree that the entire question of social standards should be studied, but I think we must have a lot of information on the issue of personal motivation.

    In the document he presented to us, Dr. Zoccolillo asks the question why people us drugs, but I found he didn't answer it really. I can't imagine why people use drugs because they think a drug is decriminalized. There have to be personal reasons that we must understand as legislators. Regardless of the regulatory framework or type of agency we will have, we must understand why, in this generation, there is a cohort of teenagers and other individuals who use more drugs. I'm still trying to see whether there are any links between drugs and suicide. It's said that we're living in a society where the suicide rate among young people is higher than it has ever been. We're also in a much more materialistic society than we have ever been in, in a society where there are means of production that did not exist for our grandparents and great-grandparents.

    Madam Chair, you asked three questions. I'm asking two. Do you have any ideas about the individual reasons why people use drugs? Why do you want an agency and what kind of agency do you want? I'm sure Jean-Sébastien has ideas on that as well.

»  (1735)  

[English]

    Dr. Mark Zoccolillo: First, I want to say that this study is at the population level, which is a bit different from something at the treatment level, so you sometimes get different responses.

    We gave the adolescents a list of different reasons they used drugs: because they didn't feel good about themselves, peer pressure, and so on. But the number one reason they said they took drugs was because it felt good, because it was fun.

    I don't know what all the things are that lead people to use drugs, but we have to be careful to look at a whole different range of reasons. For example, we have a long history of data on tobacco use. Tobacco use was very common 30 or 40 years ago because cigarette companies advertised heavily and society thought it was fun. Doctors advertised cigarettes. That has changed. The prevalence of use has dropped, but people haven't changed that much.

    There are a number of different factors that influence why people use drugs, ranging from personal factors, which may contribute to interdependence, to societal factors. There are just a lot of different things. I would be careful about assuming that there's just a single reason, and these reasons change over time.

    As far as an agency is concerned, Dr. Vamos here has also talked about how they have been regressive in the last 30 years. You need to create a governmental agency whose task is promoting reduction of harm from drug use. That's about as simple as one can put it. However you want to put it, it shouldn't be simply limited to dependence; think about tobacco. There's no reduction of harm from tobacco use because there's no safe level of tobacco, so you talk about preventing use.

    It would have to look at all these different things, look at what the best research is, subsidize programs that try to reduce harm, test these programs, and provide a model for the provinces to potentially follow. I'm not an expert on how government agencies should be set up, but that's the broad outline of what I would suggest.

[Translation]

    The Chair: Thank you very much.

    Mr. Fallu.

    Mr. Jean-Sébastien Fallu: As regards personal factors, I agree we cannot view drug use out of context. It is the interaction of all these factors that leads to drug use. As I said earlier, there are factors such as thrill seeking and aggressiveness in boys, but that can come from other things. I believe the sense of alienation in an individual has a great deal to do with that, but that factor interacts with his environment and with the way he perceives himself and feels. There may be the incoherence of the education he received. Perhaps there is an inconsistency as well between the law that prohibits and the fact that his parents use drugs. For a young person who is in the process of shaping his identity and in a period of adopting social standards and values, I'm sure it is hard to understand anything in all that.

    As for the idea of an agency, I think it's an excellent idea. If public intervention on drug use is within the jurisdiction of the Department of Justice, I believe it is bound to fail for the simple reason that the amount of money that can be devoted to law enforcement will never equal the money wielded by organized crime. It's a joke. We'll never solve the problem. Drug use exists, whether it's legal or illegal, or for therapeutic or medical use. It has existed for centuries and centuries and will always exist. I believe there is no other possible way than to move toward a health authority.

    Today, just at raves in Montreal, we see that things are going like that. It's not just raves; there are after-hours which are open on Thursdays, Friday, Saturdays and Sundays. The use of speed and amphetamines is enormous in those places. That's in the suburbs, in the areas around Montreal, and it's growing. From what I saw, the police merely arrest those who have nothing to do in any way with organized crime. The police can't arrive and stop that. At raves, I've personally seen the police search everyone at the entrance and arrest 75 individuals, including two sellers who hadn't understood that you don't go to a rave to sell drugs unless you're protected. And yet there were 200 dealers inside.

    So corruption exists and will always exist. I'm not talking about the penal administration as a whole, but there will always be corrupt individuals who will allow people to sell drugs. So I think it's obvious that we have to go toward a health approach.

»  (1740)  

    Mr. Réal Ménard: [Editor's Note: Inaudible] ...Do you agree with me?

    Mr. Jean-Sébastien Fallu: On what basis? On the basis of corruption?

    Mr. Réal Ménard: On the basis of the fact that corruption is a marginal phenomenon among those in authority.

    We have finished, Madam Chair. You're tired.

    The Chair: No, no.

    Mr. Réal Ménard: Ah, I always find it pleasant to listen to Dr. Morissette.

    Ms. Carole Morissette: I simply wanted to support the idea of an agency. I don't know whether we should call it an agency, but it is clear that, for a number of years, in the reports of intersectoral committees that have examined the drug use issue, there have been demands for joint action between departments and the creation of an authority that will at last solve the problems we are experiencing in the field when it comes to implementing programs. I also believe we have to rely on the expertise that is there. I'm certain you're already thinking of it, but I'm thinking of certain research structures that are in place and of certain groups of people who have been working for years in the field and who really need to be supported in order to do more. I think we have to rely on existing expertise in order to continue the work and perhaps create a more specific authority which can examine certain very specific points, particularly the legal point.

    That's it. Thank you very much.

    The Chair: Thank you very much everyone.

    I would like to ask a question for the people who are taking notes. What does GRIP mean, Mr. Zoccolillo?

    Dr. Mark Zoccolillo: Groupe de recherche sur l'inadaptation psychosociale chez l'enfant.

[English]

    An hon. member: Is that the same GRIP as Mr. Fallu?

    The Chair: No.

    Mr. Jean-Sébastien Fallu: It's a big confusion. It's a different GRIP.

    The Chair: Now it's on the record, so we have it.

    To all of you, merci beaucoup for coming here. Thank you very much for sharing with us your expertise. On behalf of my colleagues, both the ones here and not here, we really appreciate the benefit of your information, and we wish you very much success in the work you are doing in your respective areas. It does make a difference. Thank you very much.

    We are adjourned.